Extraction, transportation and immobilization boards are used in the medical community for transporting trauma victims. Emergency medical personnel will strap the victim to an immobilization board (backboard) whenever they know or suspect that the victim's spine has been injured. This technique is used to minimize the chance of further injury to the spine while the victim is being extracted or transported from the scene. In fact, the victim is often immobilized for hours on the backboard during transportation to the hospital and while awaiting diagnostic studies.
The practice of strapping the victim to these immobilization boards stems from the fact that many trauma victims sustained additional neurological injuries because of undiagnosed spinal instability while the victim was being lifted or carried to ambulances and hospitals. Backboards help prevent additional injuries by keeping the vertebrae aligned so as not to further compress the spinal cord and nerves which lie within a small opening in the spine, known as the vertebral canal. The victim will be left strapped to the backboard for hours during transportation to emergency facilities and while undergoing initial examination at an emergency facility.
The victim will not be taken from the backboard until the victim's spine is examined by a medical specialist (generally a neurosurgeon) who will “clear” the victim prior to the removal of the victim from the backboard. The process of “clearing” the victim involves examination of the victim (patient) and examination of x-rays. This procedure can take hours before a determination can be made of whether or not the patient can safely be removed from the backboard.
The inability to move for hours on end leads to great discomfort and, quite often, great pain for the patient. Patients have complained of pain at the back of the skull (occiput), shoulder blades (scapulas), mid back area (thoracic kyphosis), tailbone (sacrum and coccyx), pelvic areas (posterior superior iliac spines) and heels (calcaneus). These areas of the body are the same areas that have the greatest contact with the backboard. The pain arises from the patient's inability to move and take pressure off of these areas (i.e., shift the body weight). In addition, the lack of movement compromises the blood flow (perfusion) in the tissues in these regions during the period of immobilization. The compromised perfusion leads to tissue ischemia that in turn causes pain. The tissue ischemia often leads to “pressure ulcers” (decubitus ulcers). The development of these ulcers often leads to an increase in the patient's morbidity, an associated increase in the length and cost of hospitalization and to increase in the possibility of surgery or similar additional treatment.
The current art in backboards has undergone little change with regard to the above expressed concerns. It appears that backboards are designed, built and sold with a view toward cost and durability. Current improvements center about the use of stronger and more lightweight materials in order to increase the carrying capacity and decrease the load that ambulances, paramedics, and attendants must carry. Other improvements have focused on craniocervical stabilization, universal padding, addition of wheels to the backboard, folding backboards, floatable backboards, and the like. The art has not concentrated on improving patient comfort, reducing the chance of the formation of pressures ulcers, increasing tissue perfusion, and the like while the patient is immobilized on the backboard.
For example McQueen, U.S. Pat. No. 5,560,059, discloses a patient stretcher containing inflatable supports located under the neck and torso of immobilized patient. The McQueen stretcher is formed from rigid polymeric materials that incorporate a pair of depressions that contain the inflatable pads. Close inspection of the drawings show that if x-rays are taken with the patient on the board, reflection and interference will occur due to the stiffening supports associated with the stretcher. Furthermore, the inflatable pads can cause movement of the patient thus negating the effect of the spine board, and no padding is provided for the lower extremities (legs/feet).
Bologovsky et al., U.S. Pat. No. 5,950,627, disclose a spine board manufactured from a molded urethane-filled polymer shell that is stiffened with a series of carbon filament tubes. The Bologovsky device makes no effort to provide padding and states that board is x-ray transparent with the exception of the stiffening elements.
The prior art includes a series of design patents that attempt to meet the requirement for a lightweight stiff spine board. See for example, Pretzer, U.S. Pat. Des. No. 358,652 that shows no padding and Ott, U.S. Pat. Des. No. 328,351 that shows padding for only the feet. The inventor (Crutchfield) discloses a spine board, see U.S. Pat. No. Des. 471,634, that illustrates a padding system for the head/spine/torso and the legs/feet. Whereas the Crutchfield design provides padding and a stiff spine board, it was discovered that the board showed minor flexing and in particular caused interference in x-ray pictures due to the increased density of the stiffening members: like the Bologovsky device.
Kirchgeorg et al., U.S. Pat. No. 5,771,513 discloses an x-ray compatible, partially flexible patient support. The Kirchgeorg device is essentially a flexible support that wraps from one side of the patient to the other thereby retraining the patient in a blanket like structure that is stiff from the head to the feet. Some motion is still possible (hence the title “partially flexible”) which prohibits the use of the device in a patient suffering severe spinal injury.
Thus there remains a need for a carefully designed backboard that is lightweight and stiff but contains strategically located pads to reduce patient discomfort, decrease the likelihood of compromised tissue blood flow (perfusion) in pressure regions leading to an overall reduction in pain and the formation of pressure ulcers while allowing x-ray examination without interference or shadowing.